Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $80.62 / $85.68 / $171.64	Professional		$80.62	$85.68	$171.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.81 / $88.54 / $203.15	Professional	26	$65.81	$88.54	$203.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.41 / $30.41 / $55.04	Professional	TC	$30.41	$30.41	$55.04
Asuris Northwest Health Facility/Professional Facility Modifier 26 Low / Median / High Price $209.02 / $390.55 / $390.55	Facility	26	$209.02	$390.55	$390.55
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $152.46 / $280.54 / $961.80	Professional		$152.46	$280.54	$961.80
Asuris Northwest Health Facility/Professional Professional Modifier 26 Low / Median / High Price $115.96 / $211.07 / $701.55	Professional	26	$115.96	$211.07	$701.55
Asuris Northwest Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.50 / $68.89 / $340.13	Professional	TC	$36.50	$68.89	$340.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.61 / $121.32 / $169.92	Professional		$62.61	$121.32	$169.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.76 / $91.34 / $127.87	Professional	26	$41.76	$91.34	$127.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.89 / $32.54 / $50.62	Professional	TC	$16.89	$32.54	$50.62
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $83.39 / $165.31 / $257.81	Facility	26	$83.39	$165.31	$257.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.69 / $259.23 / $336.26	Professional		$147.69	$259.23	$336.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.79 / $167.08 / $235.81	Professional	26	$107.79	$167.08	$235.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $78.48 / $117.88	Professional	TC	$47.86	$78.48	$117.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $107.50 / $298.80	Professional		$25.12	$107.50	$298.80
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $121.03 / $168.84 / $171.52	Facility	26	$121.03	$168.84	$171.52
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $112.63 / $131.66 / $161.28	Professional	26	$112.63	$131.66	$161.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $35.33 / $69.14 / $100.34	Professional	TC	$35.33	$69.14	$100.34
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $160.08 / $258.51 / $310.42	Professional		$160.08	$258.51	$310.42
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $117.70 / $197.01 / $233.27	Professional	26	$117.70	$197.01	$233.27
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.32 / $65.63 / $80.06	Professional	TC	$40.32	$65.63	$80.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $152.46 / $222.24 / $273.70	Professional		$152.46	$222.24	$273.70
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $115.96 / $160.02 / $207.53	Professional	26	$115.96	$160.02	$207.53
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $36.50 / $53.59 / $91.36	Professional	TC	$36.50	$53.59	$91.36
United Facility/Professional Professional Modifier Low / Median / High Price $70.59 / $100.00 / $183.14	Professional		$70.59	$100.00	$183.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.64 / $77.31 / $185.56	Professional	26	$51.64	$77.31	$185.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.02 / $26.70 / $61.81	Professional	TC	$16.02	$26.70	$61.81